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Chapter 17 The Thigh, Hip, Groin, and Pelvis

CHAPTER 17
The Thigh, Hip, Groin, and Pelvis
OVERVIEW

The thigh is continually exposed to traumatic injuries with contusions and strains
occurring more frequently. Because of its bony, ligamentous, and muscular
arrangements, the hip joint is considered by many to be the strongest articulation in
the body. Though seldom injured, it is subject to muscular strains, contractures,
bursitis, degenerative diseases, and stresses on the epiphyseal and apophyseal
growth plates.
Those individuals that work with athletes must have a thorough knowledge of
the anatomy of the pelvis, hip, groin, and thigh area to adequately evaluate and
manage the common sports injuries associated with this area. He/she must also be
aware of possible conditions that may occur if injuries are mishandled.

LEARNING OBJECTIVES
After studying Chapter 17, the student will be able to:
Identify the bony anatomy of the thigh, hip, groin and pelvis.
Explain how to prevent injuries of the thigh, hip, groin, and pelvis.
Identify the muscles that control the movements of the thigh, hip, groin and
pelvis.
Differentiate between the different grades of quadriceps contusions and explain
how to treat each appropriately.
Explain appropriate emergency procedures for injuries that occur to the thigh,
hip, groin, and pelvis.

KEY TERMINOLOGY

Acetabulum - Deep socket of the innominate bones that contains a fat pad and
articulates with the head of the femur
Apophysis - Bony outgrowth in which major muscles make their attachments
Avascular necrosis - Death of an area or tissue due to a lack of blood supply
Ectopic bone formation - Bone formation occurring in an abnormal place
Hip pointer - Contusion to the iliac crest
Innominate bones - Composition of three bones that ossify and fuse together
early in life; these three bones are the ilium, ischium, and pubis.
Myositis ossificans traumatica - Ectopic bone deposits in muscle that result from
severe or repeated blows to the thigh
Osteitis pubis - Chronic inflammatory condition caused by repetitive stress on
the pubic symphysis and adjacent bony structures by the pull of the muscles in
the area
Pelvis - Bony ring formed by the two innominate bones, the sacrum and the
coccyx
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
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Chapter 17 The Thigh, Hip, Groin, and Pelvis

Quadriceps contusion - Compression of the muscle against the femur as a result


of severe impact to the thigh area
Sacrum - Wedge-shaped "bone" composed of five fused vertebrae

DISCUSSION QUESTIONS
1. What are the muscles of the thigh? What functions do they perform? What
nerves supply these muscles?
2. What signs and symptoms are seen in each of the three degrees of quadriceps
contusions? How are they managed?
3. What complications can occur if a thigh contusion is mishandled?
4. Why do hamstring strains often become recurrent? How are they managed?
5. Where do fractures occur most often on the femur? Where do stress fractures of
the femur most often occur?
6. What bones make up the pelvic region?
7. What structures reinforce the hip joint?
8. What muscles move the hip joint? Where do they receive their innervation and
major blood supply?
9. What are the bony and soft tissue structures that can be palpated in the hip
area?
10.What muscles are most often injured in a groin strain? How is this type of injury
managed?
11.What type of hip problems occur in the young athlete?
12.What are acute and chronic conditions of the pelvic region? How are they
managed?
CLASS ACTIVITIES
1. Demonstrate palpation of all bony and soft tissue structures to the class along
with the full evaluation methods used in estimating the extent of a hip injury.
2. Present conditions of signs and symptoms of a particular condition and have the
students identify the probable injuries or syndromes.
3. Have each student discuss a congenital or a degenerative disease of the hip and
its implications for participation in sports; have students present this material in
a report.
4. Have each student survey the types of protective equipment available to
prevent thigh and pelvis injuries and determine whether this equipment is
adequate. What other sports should require thigh, hip, and pelvic protection
against injury?
5. Have each student discuss the injuries or conditions that cause hip pain in a twoor three-page report.
WORKSHEET ANSWERS
Matching
1. i
2. h
3. g

6. b
7. a
8. k

11. d
12. j
13. b

15. d
16. c
17. f
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 17 The Thigh, Hip, Groin, and Pelvis

4. e
5. f

9. l
10. c

14. e

18. a

Short Answer
19.They all extend the knee; the rectus femoris also flexes the hip
20.Treatment should be conservative; if painful and restricts motion, the formation
should be surgically removed after 1 year with much less likelihood of its return.
If removed too early, it may return.
21.The anatomical curve is in the midsection of the femur and is, therefore, the
weakest section; also, more blows are received in this section.
22.It supports the spine and trunk and transfers the weight to the lower limbs; it
also serves to protect the pelvic viscera and to act as a point for muscular
attachments.
23.Pain in the groin that sometimes is referred to the abdomen or knee. Limping is
also typical. Examination may show limited hip movement and pain. May have
a rapid onset, but more often it comes on slowly over a number of months.
24.Rest and oral anti-inflammatory agents, with a gradual return to activity
25.Shock
26.Femur
Listing
27.Attempting to run off a quadriceps contusion
28.Massage directly over the contusion
29.Applying superficial heat to the thigh
30.Deformity, with the thigh rotated outward
31.A shortened thigh, caused by bone displacement
32.Loss of thigh function
33.Pain and point tenderness
34.Swelling of the soft tissues
Essay
35-39.See pages 276-277
40-43.Femur fracture, pelvic fracture, and hip dislocation. All of these are
emergencies because they can lead to shock; the blood supply to these areas
is large and if disrupted can be serious.

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 17 The Thigh, Hip, Groin, and Pelvis

NAME ______________________________
SECTION__________

CHAPTER 17 WORKSHEET
The Thigh, Hip, Groin, and Pelvis
MATCHING: Match the structure with the appropriate name.
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____

1. Acetabulum
2. Anterior-Superior Iliac Spine (ASIS)
3. Iliac crest
4. Ischial tuberosity
5. Obturator foramen
6. Posterior-Inferior Iliac Spine
7. Posterior-Superior Iliac Spine (PSIS)
8. Pubic crest
9. Ramus of Ischium
10. Sciatic notch
11. Spine of ischium
12. Superior ramus of pubis

MATCHING: Match the letter of the condition with the correct response.
_______
_______
_______
_______
_______
_______

13.
14.
15.
16.
17.
18.

Hip pointer
Legg-Perthes disease
Myositis ossificans
Osteitis pubis
Hip dislocation
Piriformis Syndrome

a. Caused by compression of the


sciatic nerve
b. Caused by blow to the iliac crest
c. Caused by repetitive stress to the
pubic symphysis
d. Bone formation in muscle
e. Slipping of the femoral head
f. Often associated with avascular
necrosis

SHORT ANSWER: Answer the following questions with a brief response.


19.What is the function of the quadriceps muscle group?
20.How would you manage myositis ossificans traumatica?
21.Why do most fractures occur at the middle third of the femur instead of at the
ends?
22.What are the functions of the pelvis?
23.What are the signs and symptoms of Legg-Perthes disease?
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 17 The Thigh, Hip, Groin, and Pelvis

24.How would you treat osteitis pubis?


25.What usually accompanies a fracture of the femur as a result of the pathology
and pain?
26.Which bone in the body is the longest and strongest?
LISTING: List three things that can aggravate or cause myositis ossificans in the
thigh.
27.
28.
29.
List the five classic signs of a fractured femur.
30.
31.
32.
33.
34.
ESSAY:
35-39.Describe the difference between a grade 1, 2, and 3 hamstring strain and
discuss the care for these injuries.

40-43.Which of the injuries discussed in this chapter are life-threatening


emergencies and why?

IM-17 | 5
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

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